中医三级防控模式对冠心病与脑卒中患者的管理效能评价：一项单中心、前瞻性队列研究

Background ?Cardiovascular and cerebrovascular diseases are the leading causes of death and disability globallywith existing management models facing challenges such as insufficient long-term intervention and limited effectiveness of comprehensive prevention and control. The Traditional Chinese MedicineTCM three-level prevention and control model establishes a multi-tiered system involving familiescommunitiesand hospitalscombining health educationlifestyle interventionand TCM-specific techniques to provide systematic and continuous management. Objective ?To evaluate the management effectiveness of the TCM three-level prevention and control model for patients with coronary heart diseaseCHD and strokeaiming to optimize prevention strategies for cardiovascular diseases. Methods ?A prospective single-arm cohort study was conductedenrolling 265 non-acute CHD and stroke patients from Tianjin Beichen District between October and December 2020. Using a TCM three-level prevention and control system centered on patientswith village/community physicians as executors and tertiary hospital specialists as leaderscomprehensive TCM health management interventionsincluding health educationlifestyle modificationrisk factor controlmedication guidanceand TCM techniqueswere implemented. Patients were managed and followed up over a one-year period with biannual follow-up visits. Management effectiveness was assessed through comparisons of pre- and post-management dataincluding 1-year recurrence and progression ratesmyocardial ischemia incidenceSeattle Angina QuestionnaireSAQ scoresNational Institutes of Health Stroke ScaleNIHSS scorescardiovascular prevention knowledge scorescardiovascular risk factorsand lifestyle behavior indicators. Results ?Among the 265 enrolled patients with coronary heart diseaseCHD and stroke214 were CHD patients193 with angina pectoris and 21 in a stable state post-myocardial infarction or PCIand 51 were stroke patientsall ischemic stroke. The cohort included 120 males and 145 females. By the end of the management period14 patients were lost to follow-upincluding 4 CHD patients and 10 stroke patientsleaving 251 patients who completed the study and were included in the final analysis.The study demonstrated that after 12 months of managementthe 1-year recurrence and progression rates of CHD and stroke significantly decreased compared to baselineP<0.05. For CHD managementthe incidence of myocardial ischemia reduced significantlywith the most notable improvement observed at 6 monthsP<0.05. Additionallypatients scores in the Seattle Angina QuestionnaireSAQincluding physical limitationangina stabilityangina frequencytreatment satisfactionand disease perceptionall significantly improved compared to baselineP<0.05. For stroke managementNIHSS scores significantly decreased compared to baselineP<0.05. Regarding disease awarenessthe total scores of the cardiovascular prevention knowledge questionnaire significantly increased compared to baselineP<0.05. In terms of risk factor controlsystolic blood pressure decreased significantly from baselineP0.05. In terms of lifestyle behaviorthe proportions of individuals preferring sweet and oily foods significantly decreasedP<0.05. Sleep qualityas indicated by PSQI scoresshowed significant improvementP0.05. Conclusion ?The TCM three-level prevention and control model demonstrates significant management effectiveness in reducing 1-year recurrence and progression rates of CHD and strokeenhancing disease awarenessimproving unhealthy lifestyle behaviorsand partially controlling cardiovascular risk factors. These results suggest that the model effectively stabilizes disease conditions and improves the outcomes of secondary prevention for cardiovascular diseaseshighlighting its potential for broader application.